Provider Demographics
NPI:1184909657
Name:GRATZ, KATIE SUE (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:SUE
Last Name:GRATZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:SUE
Other - Last Name:WIGGENJOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 S WHITE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2603
Mailing Address - Country:US
Mailing Address - Phone:319-385-6700
Mailing Address - Fax:
Practice Address - Street 1:501 S WHITE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2603
Practice Address - Country:US
Practice Address - Phone:319-385-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004132363A00000X
IA002235363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant